Request for Preceptor CME Credit

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					        Request for Preceptor CME Credit
Thank you for serving as a Preceptor for MSUCOM medical students. Please complete the
form below to request your CME credit. Please note that you must be clinical faculty of the
College in order to submit credit through this office. If you are not a clinical faculty
member, please consider becoming one! There is a copy of the application on our webpage
with instructions. Once your application is turned in, we will be able to process your hours.

Continuing medical education credit is hour-for-hour credit. For example, if you work 40
hours with a student, you will receive 40 credits of AOA Category IB. You should only claim
the number of hours you spent with the student.

If you are in a physician group and the student spent time with more than one physician,
you cannot claim the same hours as another physician. For example, if there are two
physicians in your practice, you cannot both claim 40 hours.

Additionally, if you had two students during the same time period, you cannot claim double
hours. For example, if you had two students for one week, you can only claim 40 hours.


Physician Name:      Click here to enter text.

AOA Number:          Click here to enter text.

Mailing Address:     Click here to enter text.

Phone Number:        Click here to enter text.

Email Address:       Click here to enter text.

Student Name:        Click here to enter text.

Type of Rotation:    Click here to enter text.

Dates of Rotation:   Click here to enter text.

Hours to report:     Click here to enter text.


        If you have any questions, please contact the CME office at 1-517-353-9714.
              This form can be sent by email to cme@com.msu.du or mailed to:
                     965 Fee Road, Room A306, East Lansing, MI 48824

				
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